1. Person compiling this form: Hank Kazmier Date: 3/15/97
      2. Address: 141 Shore Dr.
      3. Present Owner’s Name: Hank & Manda Kazmier
      4. Original Owner’s Name: Evelyn Bruner (formerly Phillips)
      5. Other owner’s and date of possession: Purchased from Evelyn Bruner 29 April 1969 (Lots 3 & 4) — 16 cottonwood trees
      6. Date built, type of construction, interesting architectural features and renovations: Designed 8-15-1949 by John Cerovski, architect, Chicago. 2 story, concrete block, cathedral ceiling
      7. What can you tell us about previous owners? – their contributions to the community, etc.
        Built by Evelyn and husband Phillips as a summer cottage. Mr. Phillips was a funeral director, Roseland, Chicago